CADAVERIC KIDNEY-TRANSPLANTATION UNDER PROPHYLACTIC POLYCLONAL ANTIBODY IMMUNOSUPPRESSION WITH ANTI-LYMPHOBLAST GLOBULIN VERSUS ANTI-THYMOCYTE GLOBULIN

Objectives. This retrospective study was undertaken to evaluate and co mpare the clinical and immunologic outcomes following prophylactic ind uction treatment with Minnesota anti-lymphoblast globulin (MALG) and U pjohn anti-thymocyte globulin (ATGAM) in cadaver renal transplantation . Methods. From 1990 to 1994, 63 patients with renal transplants from cadavers received MALG and 77 patients received ATGAM for induction tr eatment. Most pretransplant parameters were equivalent in both groups. There was no significant difference in the total dose and mean durati on of MALG/ATGAM administration. The post-transplant outcome in these groups was compared. Results. There was no difference between the MALG and ATGAM groups with respect to the overall number of rejection epis odes, median days to rejection, or the number of steroid-resistant rej ection episodes. However, MALG-treated patients experienced a greater number of rejections in the first 60 days postoperatively (P = 0.06). There was no difference in the nadir serum creatinine level in the fir st 20 postoperative days in the two groups; however, it took fewer day s to reach the nadir in the ATGAM group (P = 0.03). The incidence of d elayed graft function was higher in the MALG group than in the ATGAM g roup (38% versus 31%) but not statistically significant. Graft surviva l at 12 and 24 months was comparable in both groups. However, patient survival was superior at 12 and 24 months in ATGAM-treated transplant recipients (P = 0.03). The mean serum creatinine at 6, 12, and 24 mont hs was similar in both the MALG and ATGAM groups. The mean fall and re covery of CD3, CD4, and CD8 T-lymphocyte subsets while on MALG/ATGAM w ere similar in both groups. The incidence of infectious complications was greater in the MALG group. Conclusions. MALG and ATGAM have compar able clinical immunosuppressive effects. Patients receiving ATGAM expe rienced fewer rejections in the first 2 months, fewer infections, and better survival.